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Purpose: Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients. Method: An observational cohort design was employed. Data were extracted from the University of Wisconsin–Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions. Results: Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia ( p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score ( p = .006), and glottic closure pattern ( p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r 2 of .62. Conclusions: Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.

International audience; This paper uses the recent glottal flow model for iterative adaptive inverse filtering to analyze recordings from dysfunctional speakers, namely those with larynx-related impairment such as laryngectomy. The analytical model allows extraction of the voice source spectrum, described by a compact set of parameters. This single model is used to visualize and better understand speech production characteristics across impaired and nonimpaired voices. The analysis reveals some discriminative aspects of the source model which map to a physiological class description of those impairments. Furthermore, being based on analysis of source parameters only, it is complementary to any existing techniques of vocal-tract or phonetic analysis. The results indicate the potential for future automated speech reconstruction systems that adapt to the method of reconstruction required, as well as being useful for mainstream speech systems, such as ASR, in which front-end analysis can direct back-end models to suit characteristics of impaired speech.

To find changes in voice quality, airway invasion during swallowing, pharyngeal residue after swallowing, acoustic and aerodynamic measurements and pulmonary function tests after total parathyroidectomy plus auto-transplantation for secondary hyperparathyroidism.We recruited 38 patients who underwent successful surgery for secondary hyperparathyroidism in this study. Voice quality was evaluated using voice handicap index (VHI-10), eating assessment tool (EAT-10), voice impairment, and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. Acoustic and aerodynamic measurements included fundamental frequency (F0), maximal phonation time, high pitch, jitter, s/z, shimmer and noise-to-harmonic ratio. Vocal cord mobility, vocal cord closure, premature spillage, the penetration-aspiration scale and the Yale pharyngeal residue severity rating scale (PRSRS) after swallowing were examined using fiber-optic endoscopy. Pulmonary function tests included forced vital capacity, forced expiratory volume in 1 s, bronchodilator test, total lung capacity, diffusion capacity of the lung for carbon monoxide, alveolar volume, and distance and O2 desaturation of the 6 min walking test (6MWT).Four months after successful parathyroidectomy, VHI-10 improved significantly (p 0.01); incomplete vocal cord closure decreased significantly (p 0.01); the Yale PRSRS for vallecula and pyriform sinus improved significantly (p = 0.02 and p = 0.02); F0 and high pitch increased significantly (p 0.01 and p = 0.01); O2 desaturation (4%) of 6MWT improved significantly (p = 0.04).Parathyroidectomy for secondary hyperparathyroidism can improve the voice quality, vocal cord closure, the Yale PRSRS for vallecular and pyriform sinus and O2 desaturation of 6MWT, and increase F0 and high pitch.

Purpose: This study examined the relationship between voice quality and glottal geometry dynamics in patients with adductor spasmodic dysphonia (ADSD). Method: An objective computer vision and machine learning system was developed to extract glottal geometry dynamics from nasolaryngoscopic video recordings for 78 patients with ADSD. General regression models were used to examine the relationship between overall voice quality and 15 variables that capture glottal geometry dynamics derived from the computer vision system. Two experts in ADSD independently rated voice quality for two separate voice tasks for every patient, yielding four different voice quality rating models. Results: All four of the regression models exhibited positive correlations with clinical assessments of voice quality ( R 2 s = .30–.34, Spearman rho = .55–.61, all with p < .001). Seven to 10 variables were included in each model. There was high overlap in the variables included between the four models, and the sign of the correlation with voice quality was consistent for each variable across all four regression models. Conclusion: We found specific glottal geometry dynamics that correspond to voice quality in ADSD.

Purpose: Postswallow voice abnormality is often assumed to indicate the presence of material in the laryngeal airway (MIA), but prior research has not shown definitive evidence of a causal relationship. This study investigated if endoscopically confirmed MIA (prandial material or secretions) generates specific voice quality attributes that can be perceptually identified by experienced listeners. Method: Forty-four dysphagic adults underwent endoscopic evaluation of swallowing. Time-linked audiovisual recordings of pre- and postswallow phonation were analyzed to determine the presence, amount, and location of prandial material or secretions in the larynx during phonation. Expert listeners completed auditory-perceptual ratings of phonation samples. Results: Voice quality ratings did not differ significantly when there was MIA during postswallow phonation. However, judgments of voice quality abnormality for MIA samples were elevated when analyses controlled for effects of baseline dysphonia. Listeners were most likely to perceive voice quality abnormality when larger amounts of secretions were present, as compared to prandial material. Interrater reliability was variable and ranged from low to moderate across perceptual parameters. Conclusions: MIA during phonation occurred for many participants, but perception of voice quality abnormality was variable when MIA was present. Baseline dysphonia is common among individuals with dysphagia and may limit perception of voice quality abnormalities generated by MIA. Secretions in the laryngeal airway may have a greater impact on voice quality parameters.

The measure H1–H2, the difference in amplitude between the first and second harmonics, is frequently used to distinguish phonation types and to characterize differences across voices and genders. While H1–H2 can differentiate voices and is used by listeners to perceive changes in voice quality, its relation to voice articulation is less straightforward. Its calculation also involves practical issues with error propagation. This paper highlights some developments in the use of H1–H2 and proposes a new measure that we call “residual H1.” In residual H1, the amplitude of the first harmonic is normalized against the overall sound energy (as measured by root mean square energy) instead of against H2. Residual H1 may mitigate some of the issues with using H1–H2. The current study tests the correlation between residual H1 and electroglottographic contact quotient (CQ) and compares the ability of residual H1 vs H1–H2 to differentiate statistically across phonation types in !Xóõ and utterance-level changes in phonatory quality in Mandarin. The results show that residual H1 has a stronger correlation with CQ and differentiates contrastive and allophonic phonatory quality better than H1–H2, particularly for more constricted phonation types.

There is growing interest in research on the non-modal voice quality, creaky voice; however, its identification often relies on time-consuming manual annotation, leading to a recent focus on automatic creak detection methods. Various automatic methods have been proposed, which rely on varying types and combinations of acoustic cues for creak detection. In this paper, we compare the performance of three automatic tools, the AntiMode method, the Creak Detector algorithm, and the Roughness algorithm, against manual annotation of creak using data from 80 Australian English speakers. We explore the possibility that tools used in combination may yield more accurate creak detection than individual tools used alone. Based on method comparisons, we present options for researchers, including an “out-of-the-box” approach, which supports combining automatic tools, and propose additional steps to further improve creak detection. We found restricting analysis to sonorant segments significantly improves automatic creak detection, and tools performed consistently better on female speech than male speech. Findings support previous work showing detection may be optimised by performing a creak probability threshold sweep on a subset of data prior to applying the Creak Detector algorithm on new datasets. Results provide promising solutions for advancing efficient large-scale research on creaky voice.

Summary Objective/Hypothesis There is an increased need for vocal education programs in group fitness instructors due to the reported risk of phonotraumatic injury in this population. Most research has focused on aerobics class instructors with limited research detailing the vocal demand response of cycling instruction, specifically. We hypothesized that instruction of a single indoor cycling class would produce evidence of acute vocal fold edema manifested by worsening of acoustic and self-perceptual voice measures and changes in ratings of laryngeal appearance. Study Design Prospective Cohort study. Methods Acoustic and self-perceptual voice measures that were potentially sensitive to laryngeal edema were collected from ten cycling instructors (Mean age: 31 ± 6.14 years, 3M and 7F) before and after instruction of a typical 45-minute cycling class. Two laryngologists then rated pairs of laryngeal exams from five instructors (Mean age: 30 ± 6.22 years, 1M and 4F) on the measure of vocal fold edema using a 10-inch Visual Analogue Scale. Paired t-test comparisons were completed on normalized data to compare pre- and postinstruction. Results Majority of acoustic and self-perceptual measures significantly worsened following cycling instruction but the magnitude of change in these measures were small. In terms of laryngeal appearance, no measurable change in vocal fold edema was observed at both time points. Conclusion The vocal demand response to a single cycling class may be insufficient to cause significant vocal fold edema in our cycling instructors. Future research is required to determine the effects of repeated cycling instruction.

Introduction Revision framework surgeries might be required for unilateral vocal fold paralyses. However, outcomes and indications of revision surgeries have not been adequately documented. For a better understanding of indications for the procedure and to help in achieving better vocal outcomes, we performed a retrospective chart review of patients who underwent revision framework surgeries for unilateral vocal fold paralysis. Objectives This study aimed to present clinical features of patients who underwent revision framework surgeries for the treatment of unilateral vocal fold paralysis. Methods Of the 149 framework surgeries performed between October 2004 and October 2019, 21 revision framework surgeries were performed in 19 patients. Self-assessments by patients using the voice handicap index-10 questionnaire, and objective aerodynamic and acoustic assessments performed pre- and post-operatively were analyzed using the Wilcoxon’s signed-rank test for paired comparisons. Results Undercorrection was indicated as reasons for revision surgeries in all cases. The revision techniques included type I thyroplasty, type IV thyroplasty, and arytenoid adduction, and revision surgeries were completed without any severe complication in all cases. Pre- and post-operative voice handicap index-10 scores were obtained in 12 cases, and other parameters were evaluated in 18 cases. Significant improvements were observed in voice handicap index-10 scores, maximum phonation time, mean flow rate, Current/Direct Current ratio, and pitch perturbation quotient. Conclusion Undercorrection was observed in all patients who underwent revision framework surgeries for unilateral vocal fold paralysis, and the initial assessment and planning are thought to be important in order to avoid revision surgeries. Revision surgeries were performed safely in all cases, and significantly improved vocal outcomes were observed, even after multiple procedures. Revision surgery should be considered for patients with unsatisfactory vocal functions after primary framework surgeries for unilateral vocal fold paralysis.

Summary Introduction College students use their voices at excessively loud intensities and long durations during college fests. The accumulative effect of vocally abusive behaviors in the presence of high ambient noise, poor vocal hygiene, and other environmental factors contribute significantly towards reducing vocal effectiveness in college students. Objective The present study aimed to study the effect of a vocally demanding situation (college Fest) on perceptual and objective voice features of college students. Methodology In this study, a total number of 27 undergraduate female students participated in the age range of 18–27 years. Pre-test—post-test research design was applied. Data analysis consisted of video stroboscopic examination, acoustic analysis using the Multi-dimensional voice program (MDVP), and perceptual evaluation with the GRBAS scale. The data obtained were processed using descriptive statistics and non-parametric tests to determine the difference in each measured parameter pre- and postfest. Results and Discussion Incomplete glottis closure, asymmetric vibration of vocal folds, and aperiodicity of vocal folds increased significantly postcollege Fest. GRBAS parameters also showed a change from pre Fest scores on grade (hoarseness) increased by 38%, breathiness in 34%, roughness in 26%, Asthenia in 15%, and strain increased in 38% participants. A P-value estimation revealed significantly higher scores in Jitter percent, Shimmer percent, and relative average perturbation than pre-fest scores. Conclusion The results of the present study indicate a high risk of vocal disorders among college students post Fest. This study suggests a potential unmet need for college students to receive education before cultural events on optimal vocal usage, vocal hygiene, and an appropriate period of vocal rest.

Feminization Laryngoplasty evolved from the aim to change a voice from a male quality to a female quality. Larynx and pharynx in a male have undergone enlargement during puberty and as there is no endocrine method for shrinking structures, a surgery that reduces the size of male structures toward the size of female structures might appropriately alter the voice. A smaller larynx and pharynx might raise both the fundamental frequency of the voice and the resonant frequency of the vocal tract. The surgery is used for transgender individuals who desire a female voice, for individuals who fail speech therapy and for complications of tracheal shave procedures whereby the vocal cords have been loosened.

Summary Objective Past literature indicates that vibrato measurements of singers objectively changed (i.e., vibrato rate decreased and vibrato extent increased) from 1900 to the present day; however, historical audio recording technology may distort acoustic measurements of the voice output signal, including vibrato. As such, the listener's perception of historical singing may be influenced by the limitations of historical technology. This study attempts to show how the wax cylinder phonograph system—the oldest form of mass-produced audio recording technology—alters the recorded voice output signal of modern-day singers and, thus, provides an objective lens through which to study the effect(s) of historical audio recording technology on vibrato measurements. Methods Twenty professional Western opera singers sang a messa di voce on the vowel [a] and on the pitch C4 for male singers and C5 for female singers, three times into a flat-response omnidirectional microphone and onto an Edison Home Phonograph simultaneously. The middle 1–3 seconds (6–10 vibrato cycles) of each sample was analyzed for vibrato rate, vibrato extent, jitter (ddp), shimmer (dda), and fundamental frequency for each recording condition (wax cylinder phonograph or microphone). Steady-state and frequency-modulating sinewave test signals were also recorded under the multiple recording conditions. Results Results indicated no significant effect of recording condition on vibrato rate (mean [standard deviation], cylinder: 5.3 Hz [0.5], microphone: 5.3 Hz [0.5]) and no significant difference was found for mean fundamental frequency (cylinder: 389 Hz [137], microphone: 390 Hz [137]). A significant main effect of recording condition was found for vibrato extent (cylinder: ±103 cents [30], microphone: ±100 cents [31]). Additionally, mean jitter (ddp) (cylinder: 1.22% [1.09], microphone: 0.24% [0.12]) and mean shimmer (dda) (cylinder: 9.40% [4.90], microphone: 1.92% [0.94]) were significantly higher for the cylinder recording condition, indicating more cycle-to-cycle variability in the wax cylinder recorded signal. Analysis of test signals revealed similar patterns based on recording condition. Discussion This study validates past scholarly inquiry about vibrato measurements as extracted from digitized wax cylinder phonograph recordings by demonstrating that measured vibrato rate remains constant during both recording conditions. In other words, vibrato rate as measured from historical recordings can be viewed as an accurate representation of the historical singer being studied. Furthermore, it suggests that the value of prior vibrato extent measurements from these acoustic recordings may be slightly overestimated from the original voice output signals produced by singers near the beginning of the 20th century (i.e., a narrow vibrato extent might have been numerically smaller on average). Increased jitter and shimmer in the wax cylinder recording conditions may be indicative of nonlinearities in the phonograph recording or playback systems

Summary The goal of this study is to compare and combine different acoustic features in discriminating subjects with and without voice disorders. A database of 484 adult patients participated in the research. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. From the results of the laryngeal examination performed by a physician and the auditory-perceptual judgment performed by a Speech-Language Pathologist, the subjects were allocated to the group with (n = 52) and without (n = 432) voice disorder. Four types of acoustic features were used: traditional measures, cepstral measures, nonlinear measures, and recurrence quantification measures. Recordings comprised the emission of the vowel /e/. Quadratic discriminant analysis was used as classifier. Individual features in the context of traditional, cepstral, and recurrence quantification measures achieved an acceptable performance of ≥70%. Combination of measures improved the classifier performance. The best classification result (86.43% accuracy) was obtained by combining traditional linear and recurrence quantification measures. Results shown that Traditional, Cepstral, and recurrence quantification measures are promising features that capture meaningful information about voice production, which provides good classification performances. The findings of this study can be used to develop a computational tool for voice disorders diagnosis and monitoring.

Summary Objective To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. Methods A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. Results The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Conclusions Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.

Among singers, stigma surrounding voice injury can affect self-esteem, self-efficacy, and self-worth and can lead to hesitancy to disclose vocal injuries for fear of damaging their career. In addition, stressors in the singer-physician relationship can work against positive interactions with physicians. To date, no study has documented the perspectives of singers about voice injury and their interactions with physicians through a qualitative approach. The purpose of this study was to a) examine the perspectives and experiences of college-aged singers regarding voice injury and visiting an ear, nose, and throat physician (ENT), and b) identify behaviors of singers and ENT physicians that establish a functional and healthy relationship with the other. Following an interpretive phenomenological design, 6 collegiate singers were interviewed using a semi-structured guide, and from the results of these interviews three emergent themes were generated: a) the emotional connection of a singer and their voice, b) the presence of stigma surrounding voice injury, and c) the barriers to effective relationships between a singer and an ENT physician.

OBJECTIVE Titanium bridges are used to separate the thyroid ala during type 2 thyroplasty for adductor spasmodic dysphonia. Revision surgeries have adventitiously indicated that bridge wing failure occurs in the area of the medial hole in some cases. This study investigated the rate and cause of device malfunctions and developed an improved device. METHODS We conducted a questionnaire survey to determine the number of surgeries performed in Japan up to the end of 2014, and to obtain information about revision cases. In addition, damage analyses were performed on the fracture surfaces of recovered titanium bridges through use of scanning electron microscopy (SEM). RESULTS Between 2002 and 2014, titanium bridges were used in 385 patients. Revision surgery was performed in 19 cases. Revision surgeries revealed that in 11 cases breakage occurred in the wings of the device in the region of the medial hole. However, such fractures were not associated with any signs of recurrence or any adverse events. SEM analyses of fracture surfaces confirmed that fatigue fractures were caused by repeated bending stress in the area of the medial hole. Based on these results, the shape of the hole was changed from round to oval and the wing thickness was increased to prevent breakage. CONCLUSIONS The wings of titanium bridges may break without any associated signs, symptoms or tissue damage. Based on the malfunctions detected and analyses of the devices recovered following malfunction, changes to the specification were made for commercial development of the titanium bridge.

This study replicates and extends the recent findings of Lee, Keating, and Kreiman [J. Acoust. Soc. Am. 146(3), 1568–1579 (2019)] on acoustic voice variation in read speech, which showed remarkably similar acoustic voice spaces for groups of female and male talkers and the individual talkers within these groups. Principal component analysis was applied to acoustic indices of voice quality measured from phone conversations for 99/100 of the same talkers studied previously. The acoustic voice spaces derived from spontaneous speech are highly similar to those based on read speech, except that unlike read speech, variability in fundamental frequency accounted for significant acoustic variability. Implications of these findings for prototype models of speaker recognition and discrimination are considered.

Summary Objectives (1) To describe a combination voice rest and steroid regimen to clarify ambiguous diagnoses in singers who present with phonotraumatic lesions and (2) to determine which videostroboscopic parameters show the most consistent response to this regimen. Study Design Chart review. Methods Singers with phonotraumatic vocal fold lesions seen at a tertiary care voice center over a 10-year period were identified. Those who had uncertain diagnoses on initial presentation, completed a combination regimen including voice rest and steroids, and had follow-up examinations were included in the analysis. The effect of this combination regimen was assessed by ratings of pre- and postregimen videostroboscopy examinations and by auditory perceptual ratings. Whether the combination regimen clarified the diagnosis was noted. Results Twenty-nine singers were prescribed the combination regimen with the intent to clarify the diagnosis. In 79% (23/29) of these singers, the regimen helped clarify diagnosis, for example, ruling in or ruling out specific lesions, confirming areas of scar, or distinguishing acute from chronic phonotraumatic injury. Stroboscopic exams were improved in 86% (25/29). The most common stroboscopic finding was a reduction in the lesion size (66%). Auditory perceptual ratings improved in 48% (14/29) of patients. Conclusions A “cool down” combination of voice rest and steroids can improve diagnostic clarity in a subset of singers with phonotraumatic lesions. This combination regimen can be considered, with both the side effect profile of steroids and possible financial ramifications of strict voice rest in mind, when the initial diagnosis is unclear.

Summary Objectives Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. Methods Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. Results 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. Conclusion Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.

Purpose: The prognosis of glottic T1a laryngeal squamous cell carcinoma (LSCC) is excellent with both transoral laser surgery (TLS) and radiation therapy (RT). Our aim was to compare TLS and RT treatment results in a randomized study. Methods and Materials: Of 56 male patients with glottic T1a LSCC, 31 were randomized for TLS and 25 for RT. Survival and larynx preservation data were collected from medical records. Results: Five-year overall survival (OS) was 87%, disease-specific survival (DSS) was 97%, and recurrence-free survival (RFS) was 81% in patients treated with TLS. Five-year OS was 92%, DSS was 100%, and RFS was 88% in patients treated with RT. The primary treatment method was not associated with OS, RFS, or DSS in a log-rank test. The larynx preservation rate was similar in both groups (TLS, 97%; RT, 92%; P = .575). Conclusions: In a prospective randomized setting oncological outcomes of both treatment modalities (TLS or RT) for T1a LSCC were similar. (C) 2022 Elsevier Inc. All rights reserved.

Specific language disorder (SLD) is a neurodevelopmental disorder that characterizes language deficits together with the preservation of some cognitive domains. Voice evaluation in children with SLD should indicate and encourage a new perspective and provide us with a conceptual approach that has the potential to better understand the voice system of children with SLD by completing a guide to voice rehabilitation in these children. The aim of this research was to determine the components of the voice system, voice quality, as well as potential gender differences among children with SLD. The sample included 30 children with developmental dysphasia, aged 3 to 9 years (AS = 6.40; SD = 1.714), of whom 20 were boys and 10 were girls. The adapted Quick Screen For Voice and GRBAS scale were used to assess the voice quality. The obtained results show that the largest number of children with SLD have adequate biological predispositions for typical voice quality. A large number of children with SLD have no change in all analyzed perceptual voice parameters. The most common perceptual changes in the voice have been mild, followed by moderate, and the least common have been pronounced changes in the voice. There have been significant differences in the degree of hoarseness and hoarseness of the voice in relation to gender, more pronounced in boys (p < 0.05). Although the changes in voice quality in children with SLD have been mild, they are potentially significant for vocal pathologists, pointing to the importance of prevention, which should be implemented at an early age in order to preserve a healthy and quality voice.

Purpose: Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. Method: Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. Results: Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. Conclusion: VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. Supplemental Material: https://doi.org/10.23641/asha.19178459

Summary Objective Semioccluded vocal tract (SOVT) exercises are routinely included in many voice therapy programs because they have been shown to improve acoustic, aerodynamic, and patient-reported voice outcomes. One limitation of the traditional SOVT exercise is that the nature of phonation through straws or semioccluded oral postures allows only for single phoneme production. A variably occluded facemask (VOFM) allows for use of articulated connected speech beyond the production of single phonemes, while still providing occlusion and, presumably, the vocal efficiency benefits that arise from it. This study reports on the effect of time duration of phonation with a variably occluded facemask on voice outcomes in patients with voice disorders. Design Prospective, randomized cohort study. Methods Fifteen patients with voice disorders phonated for 5 minutes through a VOFM with diameter openings of 3.2, 6.4, and 9.6 mm. Acoustic and aerodynamic voice measures were collected before and after each occlusion trial. These results were compared to a historical patient group that received the same phonation training for 2 minutes. Results Positive effect sizes were found for acoustic and aerodynamic improvements for all patients for at least one occlusion diameter. Effect sizes for aerodynamic outcomes were greater in the 5-minute conditions for both the 9.6- and 6.4-mm occlusions than the 2-minute condition. Effect sizes for acoustic outcomes were greater in the 5 minute than 2-minute trial for the 9.6- and 6.4-mm occlusion diameter, but greater in the 2 minute than 5-minute trial for 3.2-mm diameter. Discussion This study provides evidence that all three occlusion sizes may elicit beneficial changes for different patients; however, 5 minutes of phonation into a facemask with end occlusion of 6.4-mm diameter results in improved acoustic and aerodynamic voice outcomes for many patients with voice disorders. Future studies should further explore phonatory physiologic changes of the VOFM in a larger sample of patients and translate effects into clinical treatment for patients with voice disorders.

Summary Objectives/Hypothesis To determine predictors of voice therapy initiation. Study Design Cross-sectional cohort study. Methods All patients were evaluated in an interdisciplinary model at the University of Wisconsin Voice and Swallow Clinics between June 2016 and October 2017. Patients were eligible if they were diagnosed with a voice disorder and recommended for voice therapy as the only treatment. The dependent variable was attendance in at least once voice therapy session. Independent variables included therapeutic alliance, measured using the Session Rating Scale, and patient- and disease-related factors. These factors included gender, age, distance to the clinic, education level, household composition, occupational voice demand, Voice Handicap Index score, auditory-perceptual dysphonia severity (Grade, Roughness, Breathiness, Asthenia, Strain), and medical voice diagnosis. Results Ninety-five patients were enrolled in the study. Voice therapy initiation rate was 70%. Having fewer school-aged children (5-18 years) in the household was significantly different between the group that initiated voice therapy and the group that did not (P = 0.048). There was no difference between groups for all other factors. Conclusions This investigation suggests that household composition, specifically having fewer school-aged children in the household, may predict initiation of voice therapy. This study confirms in a prospective fashion the absence of relationship between voice therapy initiation and most patient- and disease-related factors. Therapeutic alliance should be further investigated for its ability to predict voice therapy initiation using a measure that is validated for the population of patients with dysphonia.

Injection laryngoplasty (IL) is performed to reduce the gap between vocal folds induced by unilateral vocal fold paralysis (UVFP). Voice quality after IL may be different due to other factors that influence voice quality. Voice therapy has been reported to improve voice quality after IL in patients with UVFP. This study evaluated the efficacy of voice therapy combined with IL.Patients with UVFP who underwent IL as primary therapy from March 2017 to June 2019 were evaluated. The enrolled patients were divided into two groups, those who did and did not receive voice therapy after IL. Voice quality was evaluated using perceptual, acoustic, and aerodynamic parameters, and voice handicap index-30 scores one month after IL and after completing each treatment.Of 261 patients who underwent IL during the study period, 40 were enrolled, including 21 who did and 19 who did not receive voice therapy. Voice parameters one month after IL did not differ between these two groups. Jitter, shimmer, noise-to-harmonic ratio, and mean flow rate decreased, while maximum phonation time increased after voice therapy (both P0.05). In the absence of voice therapy, improved voice parameters were maintained for six months after IL. Total voice handicap index-30 scores decreased, from 35.6 to 19.1 (P0.05), in patients who received voice therapy.Voice therapy following IL is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL.

AIM To determine which acoustic parameters may be associated with vocal fatigue among college professors in Bogota-Colombia. METHOD This was a cross-sectional study including 27 voice samples of college professors. RESULTS A gender analysis showed that mean fundamental frequency increased significantly among men and women who reported vocal fatigue compared with the those without fatigue (138.2Hz vs 122.3Hz for males; and 228.7Hz vs 188.9Hz for females; Mann-Whitney U test P value

Summary Background and objective Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy and incomplete glottal closure during phonation. The extent to which the effects of presbyphonia may be compounded by age-related declines in the respiratory system and further impact communication and quality of life remains unknown. Therefore, the objective of this study was to determine how variations in respiratory function impacts voice measures in a sample of participants with presbyphonia. Methods In this pilot study, 21 participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) and voice assessments (videostroboscopy, acoustic analysis, auditory-perceptual ratings, aerodynamic assessment, and self-assessments). Factor and cluster analyses were conducted to extract voice and respiratory constructs and to identify groups of participants with similar profiles. Correlations and regression analyses were conducted to better describe the relationships between voice and respiratory function. Results Respiratory function was found to impact voice via two main pathways: through its physiological effect on voice and through its impact on general health and impairment. A lower respiratory function was associated with a lower vocal fold pliability and regularity of vibration and with an elevated aerodynamic resistance accompanied by laryngeal hyperfunction. Standardized measures of respiratory function were associated with perceived voice-related handicap. Respiratory function did not associate with voice quality, which was mostly influenced by the severity of vocal fold atrophy. Conclusion Poor respiratory health exacerbates the burden of vocal fold atrophy and, therefore, implementation of respiratory screening prior to starting voice therapy may significantly affect the treatment plan and consequently the outcomes of voice therapy in this patient population.

Acute vocal fold edema (VFE) is often a consequence of illness, allergy, or voice overuse, causing dysphonia. Although VFE typically resolves with voice rest and treatment of predisposing causes, oral glucocorticoids are often considered for performers with imminent performance demands. There are limited data about performers' perceptions of vocal change during treatment and how this relates to their ability to perform. This study aims to examine performers' self-perceptions of vocal function with steroid treatment.Fifty-five performers (34 F; 21 M) diagnosed with VFE who chose treatment with a 6-day methylprednisolone taper were prospectively assessed. They completed the Evaluation of the Ability to Sing Easily (EASE) and reported on their voice use, regimen, performance obligations, and ability to perform. Findings were compared between Day 1 and Day 6 using paired t-tests and nonparametric Wilcoxon signed-rank tests.Nearly all subjects completed scheduled performances without interruption. Following treatment, all subscales of the EASE were decreased at Day 6 (Vocal Function 29.78-20.59; Pathologic Risk Indicator 26.60-17.33; Vocal Concerns 6.10-4.20). These differences were statistically significant (p 0.0001) and greater in subjects with performances scheduled and subjects who consistently completed vocal warmups. These findings demonstrate significant improvement in several facets of performers' self-perception of function.Subjects reported significant improvement in vocal function with oral steroid treatment and were able to meet performance obligations. It remains important that steroids are not prescribed without laryngeal examination. Examination should be repeated when dysphonia persists, recurs swiftly, or when patients seek repeated treatment, as there may be increased risk of adverse outcomes, and continued steroid use may mask underlying chronic pathology that is best treated by other means.4 Laryngoscope, 132:2434-2441, 2022.

Singers, classified as "vocal performers" are at an increased risk of developing voice disorders. The area of contemporary commercial singing has not been studied as extensively as classical singing. Non-classical singing is generally considered detrimental to vocal health and thus the information on challenges contemporary commercial singers (CCS) pose to otolaryngologists and other healthcare professionals is scarce. The authors present an overview of contemporary commercial singing styles in comparison to classical singing, discuss the notion of non-classical style being harmful to vocal health, present major risk factors associated with developing voice disorders in contemporary commercial singers, and outline the diagnostic process of vocal health assessment in this group of occupational voice users. Given that contemporary commercial singers constitute a unique and vast group of elite vocal performers, the authors stress the importance of raising awareness among healthcare professionals of the fact that these patients require special considerations for voice evaluation and treatment in the occupational health and safety framework. Med Pr. 2022;73(1):33-41.

To explore the speech outcomes of adult patients through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with adult patients with unrepaired cleft palate and their non-cleft peers.Subjective evaluation indicators included speech intelligibility, nasality, and consonant missing rate, whereas objective acoustic parameters included normalized vowel formants, voice onset time, and the analysis of three-dimensional spectrogram and spectrum, were carried out on speech samples produced by 2 groups of speakers: (a) speakers with unrepaired cleft palate ( n = 65, mean age = 25.1 years) and (b) typical speakers ( n = 30, mean age = 23.7 years).Compared with typical speakers, individuals with unrepaired cleft palate exhibited a lower speech intelligibility with higher nasality and consonant missing rate, the missing rate is highest for the 6 consonants syllables The acoustic parameters are mainly manifested as differences in vowel formants and voice onset time.The results revealed important acoustical differences between adult patients with unrepaired cleft palate and typical speakers. The trend of spectral deviation may have contributed to the difficulty in producing pressure vowels and aspirated consonants in individuals with speech disorders related to cleft palate.

Transoral laser microsurgery and radiotherapy provide high and comparable cure rates for the treatment of early glottic cancer. However, the voice outcomes after treatment remain controversial. A modified type III cordectomy technique was proposed in 2006, and preliminary results showed it to be an oncologically safe method with satisfactory voice outcomes. This study aimed to evaluate oncologic and voice outcomes after long-term follow-up of these patients.Retrospective cohort study.Tertiary care academic center.Between 2006 and 2018, 42 patients with glottic cancer underwent a modified type III cordectomy. This technique resected the tumor and upper part of the vocal folds and preserved the lower part of the vocalis muscle as a scaffold to improve glottis closure. The oncologic results and voice outcomes were evaluated at a median follow-up of 68 months.The primary tumor stages included 13 T1 (31%), 26 T2 (64%), and 3 T3 (7%). Eight patients (19%) had local recurrence, and 6 underwent successful salvage with transoral laser microsurgery with or without postoperative radiotherapy with laryngeal preservation. The 5-year rate of local control was 80%; laryngeal preservation, 95%; overall survival, 89%; and disease-specific survival, 97%. The final laryngeal preservation rate was 95% (40/42). The voice outcomes were satisfactory and comparable to those of patients who underwent type I and II cordectomies.The modified type III cordectomy has been proven to be an oncologically safe method with satisfactory voice outcomes after long-term follow-up in selected cases of early glottic cancer.

This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.

Objective Hypothyroidism is a common endocrine disorder affecting various systems of the body. Only a few studies have focused on the effect of primary hypothyroidism on voice with objective parameters, and none of them compared the effect of subclinical and overt hypothyroidism on voice. The aim of the present study is to evaluate and compare the acoustic and perceptual parameters of voice in patients newly diagnosed with subclinical and overt hypothyroidism. Methods The study included 26 subclinical hypothyroidism, 26 overt hypothyroidism patients and 30 euthyroid control participants. Perceptual evaluation of voice with GRBAS (grade, roughness, breathiness, asthenia, strain) scale, voice handicap index (VHI)-10, and acoustic voice analysis by using Multi-Dimensional Voice Program were performed for all the participants. Results The voice parameters which showed a statistically significant difference between the groups were frequency parameters (Fo; p= 0.003, Fhi; p=0.010, Flo; p= 0.002) and VHI-10 (p= 0.047). A statistically significant decrease in frequency parameters and a statistically significant increase in VHI-10 were found in overt hypothyroidism group comparing with control group (Fo; p= 0.002, Fhi; p=0.009, Flo; p= 0.001 and VHI-10; p= 0.046). Voice parameters in subclinical hypothyroidism group did not show a statistically significant difference comparing with both control and overt hypothyroidism groups. Conclusion In the present study, overt hypothyroidism is found to affect frequency parameters and patients’ own subjective assessment of voice. Primary hypothyroidism does not seem to have significant effect on voice parameters until thyroxine levels are affected.

To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training.Retrospective.Retrospective review of 438 singers with phonotraumatic lesions over a 9-year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed.Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training.Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps.4 Laryngoscope, 132:2180-2186, 2022.

Introduction: Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call “Mucosal Bridge Reconstruction” (MBR), which we apply as suturing rather than resection of the MB. Methods: Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation. Results: Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery. Conclusions: According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising.

Summary Objective Several techniques have been practiced in the field of voice therapy to balance glottal pressures and improve glottal adduction. As such, Semioccluded Vocal Tract Exercises using narrow diameter straws have shown promise as a technique to increase glottal contact as reflected by Closed Quotients (CQ) measured from electroglottograph (EGG). This study explored the effect of nasal resistance (NR) technique, a manually induced NR approach, on glottal adduction in phononormal subjects as a possible new therapeutic technique to assist in glottal closure. Subjects Thirty-four vocally healthy adult females qualified for this study. All subjects were reportedly and perceptually normal. Methods Subjects were instructed to perform tasks including (a) steady modal phonation, (b) straw phonation, (c) humming, and (d) NR technique in a random order. EGG measures included calculation of the CQ and jitter during the mid-section of each stimuli for a minimum of 10 EGG cycles. One-way repeated measures ANOVAs and Bonferroni post-hoc comparisons were calculated to determine differences between each phonatory task for the outcome measures of CQ and jitter. Results Analyses revealed that the mean CQ was significantly different in all the tasks performed with humming (33.99%) at the lowest and NR technique at highest (43.88%). Though the CQ of straw phonation (40.53%) was higher than modal steady phonation (36.65%), jitter was found to be significantly lower for NR technique (0.23%). Jitter during straw phonation (0.43%) did not differ significantly from modal phonation (0.44%). Conclusion These results provide preliminary evidence that NR technique can increase CQ with lower levels of jitter compared to straw phonation using a narrow diameter of 2 mm. Future studies should expand enrollment to men, larger age ranges, and patients with hypofunctional symptoms (eg, Parkinson disease) to evaluate the potential benefits of NR as a therapeutic technique.

Introduction: Despite its clinical significance, few studies have explored the applicability of the validated Arabic version of the Voice Handicap Index (VHI-Arab) in professional voice users, especially singers. The correlation between VHI-Arab scores and acoustic measures in this targeted group remains unclear. The aim of this study was to explore Arab Kuwaiti prospective professional singers’ perception of voice handicap using the validated VHI-Arab. Additionally, we examined the association between VHI-Arab scores and acoustic measures such as fundamental frequency (F0), shimmer, jitter, and signal-to-noise ratio. Methods: VHI-Arab scores and acoustic measures of 100 adult prospective professional singers (50 females and 50 males) were compared with those of 100 adult controls (50 females and 50 males). Results: Female prospective professional singers differed significantly from female controls in terms of functional and physical subscale scores, total VHI-Arab scores, and shimmer and jitter values. Male prospective professional singers showed significant differences neither in VHI-Arab scores nor in acoustic measures; however, their shimmer values showed significant a difference. There was no correlation between VHI-Arab scores and acoustic measures. Conclusion: Kuwaiti prospective professional singers did not perceive their voice as handicapped. Female prospective professional singers had a better perception of their voice compared with female controls. The results of the current study suggest that the perception of voice handicap and acoustic measures are different attributes that do not correlate.

Summary Objectives (1) To describe factors influencing the content, timing, and intensity of pre- and postoperative voice therapy for patients undergoing phonosurgery for benign vocal fold lesions. (2) To understand experts’ rationale for decisions made. (3) To critically analyze factors influencing intervention in relation to the wider literature in order to contribute to the development of a complex intervention. Design Qualitative interview study. Setting Multidisciplinary voice clinics in England. Participants Ten expert voice therapists with a mean of 22 years experience. Main outcome measures Participants were asked to describe factors influencing their current practice and views on optimum treatment for patients undergoing phonosurgery for benign vocal fold lesions. Data were analyzed using the Framework Method of thematic analysis. Results Factors influencing intervention related to four key themes. Pathophysiological, Patient, Therapist, and Service factors influenced the content, timing, and duration of the voice therapy provided. Consensus on core elements included delivering indirect and direct therapy preoperatively to manage underlying causative factors and address patient expectations. Postoperative intervention focused on indirect therapy to facilitate wound healing and direct therapy to improve vibratory characteristics of the vocal fold. Elements of therapy were highly individualized within participants according to the four themes above, but similarity between participants on broad parameters of intervention was high. Conclusions Expert voice therapists use direct and indirect methods pre- and postoperatively to treat patients with benign vocal fold lesions. Optimizing wound healing and mobilization of the epithelium postoperatively are concerns for expert voice therapists which distinguish postoperative patients from other dysphonic patients. This study provides an insight into the factors influencing clinician's intervention provision which can contribute to the development of an optimal pre- and postoperative voice therapy intervention. Further research to refine and test the effectiveness of an intervention is now required.

Muscle tension dysphonia (MTD) is a common voice disorder in teachers in which subjective and objective dimensions of quality of voice can be impaired. The study aimed to compare voice handicap index (VHI) and dysphonia severity index (DSI) in teachers with and without MTD as well as study correlation between them.Cross-sectional survey.Fifty female teachers were enrolled in the study in two different groups (1) twenty-five teachers with MTD (with mean age of 42.62 ± 3.58 years) and (2) 25 teachers without MTD (with mean age of 44.50 ± 3.49 years). All participants completed the Persian version of VHI and underwent multiparametric measurement of voice by the DSI; these subjective and objective voice measures were compared between two groups and their relation was studied.There was significant difference in the VHI, DSI, and their components in teachers with and without MTD (P0.05). No significant correlation was found between the total score of VHI and DSI score in the teachers with MTD (rTeachers with MTD demonstrated higher voice handicap and lower voice quality compared to the teachers without MTD. Moreover, dysphonia interrupted relation between the results of self-perceived evaluation and multiparametric measurement of voice in the teachers with MTD in while these assessments were parallel in the healthy teachers. Further studies are recommended to transparent relation between objective and subjective voice assessments in healthy population.

RESUMO Objetivo verificar se existem diferenças nas medidas acústicas e da geometria orofaríngea entre indivíduos hígidos e pessoas com Doença de Parkinson, segundo a idade e sexo e investigar se há correlações entre as medidas geométricas orofaríngeas nessa população. Método participaram 40 indivíduos, sendo 20 com diagnóstico de Doença de Parkinson e 20 indivíduos hígidos, pareados por faixa etária, sexo e índice de massa corporal. As variáveis acústicas estudadas foram frequência fundamental, jitter, shimmer, glottal-to-noise excitation ratio, ruído e média da intensidade. As variáveis geométricas da orofaringe foram aferidas por faringometria acústica. Resultados as variáveis geométricas foram menores no grupo com Doença de Parkinson e os idosos com Doença de Parkinson apresentaram menor área da junção orofaríngea que os idosos hígidos. Com relação aos parâmetros acústicos vocais, o valor da frequência fundamental foi menor no sexo masculino, no grupo com Doença de Parkinson e os valores de jitter foram maiores no grupo não idoso dos sujeitos com Doença de Parkinson. Houve correlação positiva moderada entre o comprimento e volume da cavidade oral, comprimento da cavidade faríngea e o comprimento do trato vocal e do volume da cavidade faríngea e o volume do trato vocal. Conclusão indivíduos com Doença de Parkinson apresentaram menores valores de área glótica e área da junção orofaríngea, comparativamente aos hígidos. Quando distribuídos por faixa etária e sexo, a frequência fundamental foi menor no grupo com doença de Parkinson, na população masculina. Houve correlação positiva moderada entre as medidas de comprimento e volume da orofaringe, na amostra estudada. ABSTRACT Purpose to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. Methods 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. Results geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. Conclusion individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

Summary Objectives This paper aims to study the effect of room acoustics and phonemes on the perception of loudness of one's own voice ( autophonic loudness) for a group of trained singers. Methods For a set of five phonemes, 20 singers vocalized over several autophonic loudness ratios, while maintaining pitch constancy over extreme voice levels, within five simulated rooms. Results There were statistically significant differences in the slope of the autophonic loudness function (logarithm of autophonic loudness as a function of voice sound pressure level) for the five phonemes, with slopes ranging from 1.3 (/a:/) to 2.0 (/z/). There was no significant variation in the autophonic loudness function slopes with variations in room acoustics. The autophonic room response , which represents a systematic decrease in voice levels with increasing levels of room reflections, was also studied, with some evidence found in support. Overall, the average slope of the autophonic room response for the three corner vowels (/a:/, /i:/, and /u:/) was −1.4 for medium autophonic loudness. Conclusions The findings relating to the slope of the autophonic loudness function are in agreement with the findings of previous studies where the sensorimotor mechanisms in regulating voice were shown to be more important in the perception of autophonic loudness than hearing of room acoustics. However, the role of room acoustics, in terms of the autophonic room response, is shown to be more complicated, requiring further inquiry. Overall, it is shown that autophonic loudness grows at more than twice the rate of loudness growth for sounds created outside the human body.

Punjabi is an Indo-Aryan language which contrasts a rich set of coronal stops at dental and retroflex places of articulation across three laryngeal configurations. Moreover, all these stops occur contrastively in various positions (word-initially, -medially, and -finally). The goal of this study is to investigate how various coronal place and laryngeal contrasts are distinguished acoustically both within and across word positions. A number of temporal and spectral correlates were examined in data from 13 speakers of Eastern Punjabi: Voice Onset Time, release and closure durations, fundamental frequency, F1-F3 formants, spectral center of gravity and standard deviation, H1*-H2*, and cepstral peak prominence. The findings indicated that higher formants and spectral measures were most important for the classification of place contrasts across word positions, whereas laryngeal contrasts were reliably distinguished by durational and voice quality measures. Word-medially and -finally, F2 and F3 of the preceding vowels played a key role in distinguishing the dental and retroflex stops, while spectral noise measures were more important word-initially. The findings of this study contribute to a better understanding of factors involved in the maintenance of typologically rare and phonetically complex sets of place and laryngeal contrasts in the coronal stops of Indo-Aryan languages.

Aim: The aim of the study was to analyze the impact of the COVID-19 pandemic and the related change of the teaching mode from stationary to distance learning on the severity of voice-related ailments among teachers. Materials and methods: A questionnaire survey of teachers was conducted to assess voice disorders during stationary and remote work using the Vocal Tract Discomfort (VTDs) scale and Numeric Rating Scale (NRS), and the respondents’ subjective feelings were assessed. Demographic and environmental factors associated with voice work were examined. Data on sickness absence, which were obtained from the “Health Needs Maps 2020” Ministry of Health’s, were also analyzed. Responses were subjected to statistical analysis. A P-value level below 0.05 was considered statistically significant. Results: 128 teachers participated in the survey. The overall assessment of voice disorders using VTDs and NRS scales showed no statistically significant differences for complaints between stationary and remote work. Detailed analysis revealed more se-vere voice disorders in teachers working more than 6 months remotely (P = 0.049) and having more than 20 lessons per week (P = 0.012). Subjective assessment confirmed a significantly lower percentage of teachers reporting voice disorders when wor-king remotely compared to stationary (P = 0.043). This resulted in less sickness absence and a 40% decrease in sick leave related to voice disorders in 2020 compared to 2019. Conclusions: During the remote learning period of the COVID-19 pandemic, teachers reported lower severity of voice disor-ders and this influenced the reduction of sickness absences. There were no statistically significant differences in voice complaints as assessed by VTDs and NRS scales for both teaching modes. Several factors affecting the severity of vocal tract disorders were identified – the number of class hours per week (>20) for stationary teaching and a long period of remote teaching (>6 months).

Purpose: Physically active adults have experienced training benefits from fish oil–derived omega-3 fatty acid (FO n3), which may also be of benefit to singers. The purpose of this research study was to determine if self-reported vocal adaptations and body composition changes occur in singers following FO n3 supplementation in conjunction with a singer's normal training regimen. Method: Twenty college students, currently enrolled in vocal lessons at a university, were randomized to receive either 3.0 g of FO n3 or placebo, which they took during a 10-week study period. Participants were blinded to group assignment. Participants completed the Reflux Symptom Index (RSI), Singing Voice Handicap Index-10 (SVHI-10), and the Evaluation of Ability to Sing Easily (EASE) and submitted to body composition measures (weight, skeletal mass, and body fat mass) before and after the study period. Results: Sixteen participants completed all parts of the study protocol. Mean compliance for the placebo group (83.9%) and the supplement group (75.2%) was similar. There were no significant differences in body composition measures, RSI scores, and EASE scores between groups. Scores on the SVHI-10 decreased significantly over time for all participants. Conclusions: Improvements seen in the SVHI-10 were not meaningfully different between the supplement and placebo group, pointing to the benefit of weekly lessons. The lack of changes in the questionnaire scores in the supplement group are partially attributed to the low compliance rate and low sample size, which is supported by the lack of change in the body composition measures.

Although the cepstral peak prominence (CPP) and its variant, the cepstral peak prominence smooth (CPPS), are considered to be robust acoustic measures for the evaluation of dysphonia, whether they are sensitive to capture early voice changes in Parkinson's disease (PD) has not yet been explored. This study aimed to investigate the voice changes via the CPP measures in the idiopathic rapid eye movement sleep behavior disorder (iRBD), a special case of prodromal neurodegeneration, and recently diagnosed and advanced-stage Parkinson's disease (AS-PD) patients using different speaking tasks across noise-free and noisy environments. The sustained vowel phonation, reading of passages, and monologues of 60 early stage untreated PD, 30 advanced-stage Parkinson's disease, 60 iRBD, and 60 healthy control (HC) participants were evaluated. Significant differences were found between the PD groups and controls in sustained phonation via the CPP (p0.05) and CPPS (p0.01) and the monologue via the CPP (p0.01), although neither the CPP nor CPPS measures were sufficiently sensitive to capture the possible prodromal dysphonia in the iRBD. The quality of the CPP and CPPS measures was influenced substantially by the addition of ambient noise. It was anticipated that the CPP measures might serve as a promising digital biomarker in assessing the dysphonia from the early stages of PD.

Background Long-term dysphonia may persist after thyroid surgery even in the absence of overt nerve injury. Therefore, we evaluated long-term dysphonia after thyroidectomy using a validated survey. Methods Patients undergoing thyroidectomy at a single institution from 1990 to 2018 were surveyed via telephone to complete the Voice Handicap Index-10 Survey. Individuals with documented nerve injury were excluded. Results In total, 308 patients completed the survey (mean age 51 ± 14 years, 78% female). Median time since surgery was 10.7 (interquartile range 2.3–17.5) years. The mean Voice Handicap Index-10 Survey score was 2.6 ± 5.2. Of the 113 (37%) patients who reported subjective dysphonia, the mean Voice Handicap Index-10 Survey score was 7.1 ± 6.5. Twenty-two (7.1%) patients had a Voice Handicap Index-10 Survey score above the empiric normative cutoff of 11, with a mean score of 17.6 ± 6.8. The most frequent complaints included “The clarity of my voice is unpredictable” (N = 71, 23%), “People have difficulty understanding me in a noisy room” (N = 70, 23%), and “I feel as though I have to strain to produce voice” (N = 65, 21%). Conclusion Long-term follow-up of patients after thyroidectomy suggests that more than 30% without nerve injury report dysphonia. Research to further assess the etiology and impact of these changes on quality of life is needed.

OBJECTIVES/HYPOTHESIS Evaluation of the clinical outcomes after 6 months of treatment with a novel adjustable implant, the APrevent® Vocal-Implant-System (VOIS), in conjunction with medialization thyroplasty (MT) in patients with unilateral vocal fold paralysis. STUDY DESIGN Prospective case series study at single tertiary referral center. METHODS Preoperative and 1 week, 7 weeks, and 6 months postoperative glottal efficiency (maximum phonation time [MPT]), voice quality (including GRBAS-scores and acoustic parameters) and self-perceived voice-related handicap (voice handicap index [VHI-30]) were measured and analyzed, whereas type of vocal fold closure was evaluated and determined by flexible videolaryngoscopy based on Sodersten and Lindestad classification (Wilcoxon signed-rank test). RESULTS Thirteen patients underwent MT with VOIS under local anesthesia. Six months after surgery, the VHI-30 and MPT had improved from a preoperative mean of 75.0 ± 22.9 and 2.7 ± 2.1 s to a postoperative mean of 20.6 ± 19.7 and 6.3 ± 4.0 s, respectively. The mean GRBAS score improved from preoperative scores of Gpreop = 2.7, Rpreop = 2.6, Bpreop = 2.6, Apreop = 2.2, and Spreop = 2.0 to Gpostop = 0.3, Rpostop = 0.3, Bpostop = 0.2, Apostop = 0.2, and Spostop = 0.3 at 6 months postoperatively. Improved glottal closure was achieved in all patients (n = 13). Five patients received postoperative adjustment for the optimization of voice quality and glottal closure. No intra- or postoperative complications were observed. Significant improvements in acoustic parameters, including percentage jitter, percentage shimmer, and signal-to-noise ratio, were also observed after MT. All results were statistically significant (P .8). CONCLUSIONS APrevent® VOIS-Implantation is a safe procedure with good voice outcomes. Postoperative adjustments can be performed smoothly to optimize voice quality and glottal closure. LEVEL OF EVIDENCE III Laryngoscope, 2021.

OBJECTIVE To assess long-term outcomes of ALA-PDT in treating recalcitrant laryngeal leukoplakia. STUDY DESIGN Retrospective Case-Control. METHODS We reviewed all laryngeal leukoplakia patients treated with ALA-PDT compared with angiolytic laser treatment alone (585 nm PDL or 532 nm KTP laser) from 2000 to 2019. Patients with laryngeal cancer (or a history of laryngeal cancer), leukoplakia previously treated with radiation and no pathologic report were excluded. Patient demographics, procedure details and outcomes were examined including histopathologic diagnosis, procedures performed, ALA usage, recurrence of leukoplakia and the development of cancer. RESULTS We identified 132 patients with laryngeal leukoplakia: 42 were treated with ALA-PDT and 90 were treated with an angiolytic laser alone (Laser group). The proportion of cases of high-grade dysplasia was 57.1% in the ALA-PDT group compared to 32.2% in the Laser group. In high-grade dysplasia cases, there was a statistically significant better recurrence-free survival (RFS) at 12 months and 60 months in those who underwent ALA-PDT 71.4% and 7.1% vs Laser 25% and 0% (p = .01). However, for overall groups, there was no difference in RFS (p = .25). Voice outcomes (patient subjective report) improved or were stable in 75% of subjects with no serious side effects reported. CONCLUSION ALA-PDT for recalcitrant and high-grade dysplasia is highly effective with improved recurrence-free survival compared to laser alone. ALA-PDT may be an appropriate therapy in patients who have failed prior angiolytic laser alone.

Purpose This study primarily aimed at observing the possible tissue mobilization on facial, neck, and chest tissues caused by different double source of vibration semioccluded vocal tract exercises (DSV-SOVTEs). Another goal was to inspect the degree of self-perceived sensation of a massage-like sensation. Method Fifty-five participants engaged in a set of several DSV-SOVTEs: (a) phonation with a silicone tube submerged 2 and 8 cm below water surface, (b) Acapella Choice device, (c) lip trills, and (d) tongue trills. A self-perceived massage-like sensation was also assessed. All exercises were performed at three loudness levels. Tissue mobilization signal was captured by four accelerometers placed in four different body regions: (a) over the cheek, (b) over the neck, (c) over the thyroid cartilage, and (d) over the suprasternal notch. Results There is a differential effect of all DSV-SOVTEs on tissue mobilization. All four observed dependent variables from tissue oscillation modulation (frequency, amplitude, jitter, and shimmer) showed significant three-way interactions. In general, amplitude and frequency of tissue oscillation modulation increases with loudness. A self-perceived massage-like sensation showed highly significant differences between DSV-SOVTEs. Conclusions All DSV-SOVTEs do mobilize tissues. Type of exercise, loudness level, and body region produce an effect on all tissue oscillation variables. Acapella device produces the largest amplitude of vibration, lowest frequency, and more regular oscillation of tissue. Water resistance therapy showed the most irregular tissue oscillation. Control of these variables is likely to be relevant to obtain the best outcomes in patients.

Purpose The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint. Method This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period. Twenty-two clinical objective and subjective measures of voice were extracted from 676 charts (310 males, 366 females). To identify the underlying concepts addressed in an initial voice assessment, principal component analyses were conducted for males and females to account for sex differences. Linear regression models were conducted to examine the relationship between the principal components and patient perceived severity. Results Seven principal components were identified for both sexes and accounted for 75% and 71% of the variance in the clinical measures, respectively. Of these seven principal components, only two predicted male patient perceived severity, which accounted for 22% of the variance. In contrast, four principal components predicted female patient perceived severity of their voice disorder and accounted for 19% of the variance. Conclusions The results highlight the underlying aspects of vocal quality and functioning that are evaluated during an initial assessment. Male and female patients differ in which of these components may contribute self-perceived severity of a voice disorder. Identifying these underlying components may support clinical decision making when developing a clinical protocol and highlights the overlap between patient concerns and clinical measures. Supplemental Material https://doi.org/10.23641/asha.16879603